Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, US Department of Veterans Affairs, Boston, MA, USA.
Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
J Gen Intern Med. 2019 Jan;34(1):132-136. doi: 10.1007/s11606-018-4708-z. Epub 2018 Oct 18.
To examine associations between patient perceptions that their provider was knowledgeable of their medical history and clinicians' early adoption of an application that presents providers with an integrated longitudinal view of a patient's electronic health records (EHR) from multiple healthcare systems.
This retrospective analysis utilizes provider audit logs from the Veterans Health Administration Joint Legacy Viewer (JLV) and patient responses to the Survey of Patient Healthcare Experiences Patient-Centered Medical Home (SHEP/PCMH) patient satisfaction survey (FY2016) to assess the relationship between the primary care provider being an early adopter of JLV and patient perception of the provider's knowledge of their medical history. Multivariate logistic regression models were used to control for patient age, race, sex education, health status, duration of patient-provider relationship, and provider characteristics.
The study used responses from 203,903 patients to the SHEP-PCMH survey in FY2016 who received outpatient primary care services from 11,421 unique providers. Most (91%) clinicians had no JLV utilization in the 6 months prior to the studied patient visit. Controlling for patient demographics, length of the patient-provider relationship, and provider and facility characteristics, being an early adopter of the JLV system was associated with a 14% (adj OR 1.14, p < 0.000) increased odds that patients felt their provider was knowledgeable about their medical history. When evaluating the interaction between duration of patient-provider relationship and being an early adopter of JLV, a greater effect was seen with patient-provider relationships that were greater than 3 years (adj OR 1.23, p < 0.000), compared to those less than 3 years.
Increasing the interoperability of medical information systems has the potential to improve both patient care and patient experience of care. This study demonstrates that early adopters of an integrated view of electronic health records from multiple delivery systems are more likely to have their patients report that their clinician was knowledgeable of their medical history. With provider payments often linked to patient satisfaction performance metrics, investments in interoperability may be worthwhile.
研究患者对其医疗服务提供者了解其病史的感知与临床医生对一种应用程序的早期采用之间的关联，该应用程序为医疗服务提供者提供了来自多个医疗保健系统的患者电子健康记录（EHR）的综合纵向视图。
本回顾性分析利用退伍军人事务部联合遗产查看器（JLV）的提供者审核日志和患者对 2016 财年患者医疗体验以患者为中心的医疗之家（SHEP/PCMH）患者满意度调查（SHEP/PCMH）的调查结果来评估初级保健提供者是否是 JLV 的早期采用者以及患者对提供者了解其病史的感知之间的关系。使用多变量逻辑回归模型来控制患者年龄、种族、性别、教育程度、健康状况、医患关系持续时间以及提供者特征。
本研究使用了 2016 财年 SHEP-PCMH 调查中 203903 名接受过门诊初级保健服务的患者的回复，这些患者来自 11421 名独特的提供者。在研究患者就诊前的 6 个月内，大多数（91%）临床医生没有使用 JLV。在控制患者人口统计学、医患关系持续时间以及提供者和医疗机构特征的情况下，JLV 系统的早期采用者与患者认为其提供者了解其病史的可能性增加了 14%（调整后的优势比 1.14，p<0.000）。当评估患者-提供者关系持续时间与 JLV 早期采用者之间的交互作用时，与关系持续时间少于 3 年的患者相比，与关系持续时间超过 3 年的患者的影响更大（调整后的优势比 1.23，p<0.000）。
提高医疗信息系统的互操作性有可能改善患者护理和患者对护理的体验。本研究表明，来自多个交付系统的电子健康记录综合视图的早期采用者更有可能让患者报告其临床医生了解其病史。由于提供者的报酬通常与患者满意度绩效指标挂钩，因此在互操作性方面的投资可能是值得的。
